Nicolas Williet1, Léa Clavel2, Aurélie Bourmaud3, Céline Verot2, Nadia Bouarioua2, Xavier Roblin2, Philippe Merle4, Jean-Marc Phelip5. 1. Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France. Electronic address: nicolas.williet@chu-st-etienne.fr. 2. Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France. 3. Department of Public Health, Hygée Center, Saint Priest en Jarez, France; Inserm, Clinical Investigation Center 1408, Saint-Etienne, France. 4. Hepatology Unit, Hospital Group of North Lyon, Civic Hospice of Lyon, Claude Bernard Lyon 1 University, Research center for oncology of Lyon; INSERM 1052, Lyon Cedex 03, France. 5. Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France; University Jean Monnet, LINA EA 4624, France.
Abstract
INTRODUCTION: Use of sorafenib remains debated in elderly patients treated for advanced hepatocellular carcinoma (HCC). METHODS: This was a bicentric retrospective study including all patients ≥75years and treated with sorafenib for advanced HCC between January 2010 and March 2014. RESULTS: Of the 51 patients included (median age: 78 years, range: 75-92; performance status (PS) 0-1: 98%; cirrhosis: 88.2%; Child-Pugh A: 95.6%) all experienced at least one adverse event (AE). About 2/3 of them (66.7%) had grade 3-4 toxicities, including fatigue (43.1%), hand foot skin syndrome (11.8%), anorexia (9.8%) or diarrhea (9.8%). After adjustment for arterial hypertension, heart failure, other(s) cardiovascular history(ies), and sorafenib dose at baseline, only patients ≥80 years were associated with severe AE (OR: 13.3; p=0.009). Discontinuation for toxicity was reported in 31 (60.8%) patients, mainly within the 3rd months, especially in those who had PS ≥1 at baseline (OR: 10.4; p=0.01), or other cardiovascular histories (OR: 30.9; p=0.016). In this setting, overall survival was significantly reduced (HR: 4.5; p<0.0001). CONCLUSION: Tolerance of Sorafenib seems to be low in elderly, especially for patients aged ≥80 years or with PS ≥1. Starting with reduced dose of sorafenib does not seem to impact results. Some of these patients may truly benefit from the treatment in terms of survival.
INTRODUCTION: Use of sorafenib remains debated in elderly patients treated for advanced hepatocellular carcinoma (HCC). METHODS: This was a bicentric retrospective study including all patients ≥75years and treated with sorafenib for advanced HCC between January 2010 and March 2014. RESULTS: Of the 51 patients included (median age: 78 years, range: 75-92; performance status (PS) 0-1: 98%; cirrhosis: 88.2%; Child-Pugh A: 95.6%) all experienced at least one adverse event (AE). About 2/3 of them (66.7%) had grade 3-4 toxicities, including fatigue (43.1%), hand foot skin syndrome (11.8%), anorexia (9.8%) or diarrhea (9.8%). After adjustment for arterial hypertension, heart failure, other(s) cardiovascular history(ies), and sorafenib dose at baseline, only patients ≥80 years were associated with severe AE (OR: 13.3; p=0.009). Discontinuation for toxicity was reported in 31 (60.8%) patients, mainly within the 3rd months, especially in those who had PS ≥1 at baseline (OR: 10.4; p=0.01), or other cardiovascular histories (OR: 30.9; p=0.016). In this setting, overall survival was significantly reduced (HR: 4.5; p<0.0001). CONCLUSION: Tolerance of Sorafenib seems to be low in elderly, especially for patients aged ≥80 years or with PS ≥1. Starting with reduced dose of sorafenib does not seem to impact results. Some of these patients may truly benefit from the treatment in terms of survival.
Authors: Sukeshi Patel Arora; Gabor Liposits; Susan Caird; Richard F Dunne; Gordon Taylor Moffat; David Okonji; Maria Grazia Rodriquenz; Divyanshu Dua; Efrat Dotan Journal: J Geriatr Oncol Date: 2019-11-06 Impact factor: 3.599
Authors: Clemens Schotten; Lars P Bechmann; Paul Manka; Jens Theysohn; Alexander Dechêne; Amr El Fouly; Francesco Barbato; Ursula Neumann; Sonia Radünz; Svenja Sydor; Dominik Heider; Marino Venerito; Ali Canbay; Guido Gerken; Ken Herrmann; Heiner Wedemeyer; Jan Best Journal: Liver Cancer Date: 2019-07-29 Impact factor: 11.740